Manual therapy for chronic mechanical neck pain

Chronic mechanical neck pain (NP) is an increasingly common condition globally, with up to 71% of the population experiencing it at some point in their life. Of this group, 50% will have some chronicity of symptoms.

NP, often referred to as non-specific neck pain - as there is no specific identifiable cause - presents with a range of impairments including: restriction in range of movement, weakness in the deep neck flexors as well as reduced muscle thickness around the neck.

Physiotherapy interventions have shown to be effective at increasing range of movement and reducing pain in NP, although currently the evidence is mixed regarding which specific intervention or combination of interventions provides optimal outcomes for individuals with NP.

A recent study looked at whether the addition of manual therapy to exercise training led to improved outcomes in a group of individuals with NP.

Baseline measurements of pain, range of movement and several other validated outcomes were taken from 68 volunteers with NP. Post measurement, the volunteers were split into 2 groups and received 10 weeks of routine physiotherapy or routine physiotherapy with added cervical joint mobilisations.

The routine therapy intervention included postural advice, therapeutic ultrasound, TENS as well as neck and scapular strengthening exercises. The intervention group received, supplementary to the routine therapy, weekly sessions of posterior anterior and unilateral posterior anterior mobilisations as described by Maitland.

Post-trial outcome measurements showed that both groups had significant improvement in all outcomes tested. However, it was noted that the manual therapy group had a further, statistically significant improvement in range of movement, pain and neck disability when compared to the routine therapy group.

The results of this trial suggest that the addition of manual therapy to a physiotherapist supervised exercise program is safe, and leads to better outcomes in patient with NP. As such, the use of low velocity cervical joint mobilisations, where not contraindicated, should be considered for use when treating patients with chronic mechanical neck pain.

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